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Flashcards in Step 1 Endo Deck (48):
1

What does insulin do?

Increase glucose stored as glycogen in liver
Increase glycogen and protein synthesis in muscle
Increase triglyceride storage
Increase potassium uptake in cell

2

What are the short-acting insulins?

"No LAG"
Lispro
Aspart
Glulisine
Rapid acting: 1-hour peak

3

What is the intermediate-acting insulin?

NPH

4

What are the long-acting insulins?

No real peak
Detemir
Glargine

5

What do amylin analogs do?

Decrease glucagon release
Decrease gastric emptying
Increase satiety
**INJECTIBLE**

6

What is the key example of amylin analog?

Pramlintide
**INJECTIBLE**

7

What do GLP-1 analogs do?

Decrease glucagon release
Decrease gastric emptying
Increase satiety
Increase glucose-dependent insulin release
**INJECTIBLE**

8

What are the key examples of GLP-1 analogs?

Exenatide
Liraglutide
**INJECTIBLE**

9

What do biguanides do?

Inhibit hepatic gluconeogensis and the action of glucagon by inhibiting mGPD
Increase glycolysis and peripheral glucose uptake (increasing insulin sensitivity)

10

What is the key example of a biguanide?

Metformin

11

What do sulfonylureas do?

Close K+ channel in pancreatic beta cell membrane causing cell to depolarize and insulin to be released via increased calcium influx

12

What are the key examples of a sulfonylureas?

1st gen: chlorpropramide, tolbutamide
2nd gen: glimepiride, glipizide, glyburide

13

What do meglitinides do?

Close K+ channel in pancreatic beta cell membrane causing cell to depolarize and insulin to be released via increased calcium influx
V. sim to sulfonylureas, but different binding site

14

What are the key examples of a meglitinides?

Nateglinide
Repaglinide

15

What do DPP-4 inhibitors do?

Inhibit DPP-4 enzyme that deactivates GLP-1
Decrease glucagon release
Decrease gastric emptying
Increase glucose-dependent insulin release
Increase satiety

16

What are the key examples of a DPP-4 inhibitors?

Linagliptin
Saxagliptin
Sitagliptin

17

What do glitazones/thiazolidinediones do?

Binds to PPAR-g nuclear transcription regulator
Increases insulin sensitivity and levels of adiponectin
Regulates glucose metabolism and fatty acid storage

18

What are the key examples of glitazones/thiazolidinediones?

Pioglitazone
Rosiglitazone

19

What do sodium-glucose cotransporter-2 inhibitors do?

Block reabsorption of glucose in proximal convoluted tubule

20

What are the key examples of sodium-glucose cotransporter-2 inhibitors?

Canagliflozin
Dapagliflozin
Empagliflozin

21

What do alpha glucosidase inhibitors do?

Inhibit intestinal brush-border alpha glucosidases leading to delayed carb hydrolysis and glucose absoprtion
leading to decrease postprandial hyperglycemia

22

What are the key examples of alpha glucosidase inhibitors?

Acarbose
Miglitol

23

Which hyperthyroidism meds can be used in pregnancy?

PTU used in first trimester of pregnancy (due to methimazole teratogenicity)
Methimazole used in second and third trimesters of pregnancy (due to risk of PTU-induced hepatotoxicity)

24

How is Graves ophthalmopathy treated?

Corticosteroids, NOT PTU/methimazole

25

What is the most concerning side effect of PTU/methimazole?

agranulocytosis
aplastic anemia

26

What are the ADH antagonists? How do they work?

conivaptan
tolvaptan
They block the action of ADH at the V2 receptor

Also use demeclocycline (member of tetracycline family)

27

What is somatostatin/octreotide used for?

Acromegaly
Carcinoid syndrome
Gastrinoma
Glucagonoma
Esophageal varices

28

What is cinacalcet?

Sensitizes calcium-sensing receptor (CaSR) in parathyroid gland to circulating calcium, leading to decrease in PTH
Used in refractory hypercalcemia in prior and secondary hyperparathyroidism

29

What is sevelamer?

Nonabsorbable phosphate binder that prevents phosphate absorption from the GI tract

30

Which hormones are in the cAMP class?

FSH
LH
ACTH
TSH
PTH
hCG
CRH
glucagon
(so much of FLAT PIG)

31

Which hormones are int he cGMP class?

NO
ANP

32

Which hormones are in the IP3 class?

GnRH
GHRH
oxytocin
TRH

33

Which hormones are in the steroid receptor class?

Estrogen
Testosterone
Glucocorticoids
Vitamin D
Aldosterone
Progesterone
T3/T4

34

Which hormones are in the tyrosine kinase class?

Insulin
growth factors (IGF, PDGH)
GH
Prolactin

35

Why is there (often) anovulatory infertility during nursing?

Prolactin is elevated through stimulation by sucking. Prolactin inhibits GnRH secretion, which prevents ovulation.

36

What is an odd presentation of hyperprolactinemia seen in men?

Malaise
Depression

37

How does bromocriptine work?

Dopamine agonist
Thereby it inhibits prolactin secretion by the anterior pituitary

38

How can head trauma affect prolactin?

Severed pituitary stalk disrupts the tuberoinfandibular tract (source of dopamine)
Therefore hyperprolactinemia results
Plasma levels of all other anterior pituitary hormones will DECREASE will a severed stalk

39

What medications should be used in acromegaly?

Somatostatin (and octreotide, its analog), which is normally secreted by the hypothalamus, inhibits GH secretion by the anterior pituitary.

40

Why do the alpha-glucosidase inhibitors cause frequent GI symptoms and annoying flatulence?

This class of drugs, which includes acarbose and miglitol, work by inhibiting intestinal alpha glucosidases (maltase, sucrase, isomaltase) that break down disaccharides into monosaccharides that can be absorbed by the intestines. The undigested sugars are metabolized by colonic bacteria to generate large volumes of gas.

41

What are some side effects of sulfonylureas?

Weight gain, since insulin stimulates fat synthesis
May cause hypoglycemia
First-generations could cause disulfiram-like reactions, so they are now rarely used

42

MEN 1

Pituitary tumors (prolactin or GH)
Pancreatic endocrine tumors (Zollinger-Ellison, insulinomas, VIPomas, glucagonoma)
Parathryoid adeonoma

Associated with mutation of MEN1, angiofibromas, collagenomas, meningiomas

3 P's: pituitary, pancreas, parathyroid

43

MEN 2A

Parathyroid hyperpasia
Medullary thyroid carcinoma
Pheochromocytoma

Associated with mutation in RET in cells of neural crest origin

2 P's: parathyroid, pheochormocytoma

44

MEN 2B

Medullary thyroid carcinoma
Pheochromocytoma
Mucosal neuromas (oral/intestinal ganglioneuromatosis)
Associated with marfanoid habitus; mutation in RET gene

1 P: pheochormocytoma

45

Demeclocycline

ADH antagonist (member of tetracycline family)
Used in SIADH
SEs: nephrogenic DI, photosensitivity, abnormalities of bone and teeth

46

Fludrocortisone

Synthetic analog of aldosterone with little glucocorticoid effects
Used as mineralcorticoid replacement in primary adrenal insufficiency
SEs are similar to glucocroticoids

47

Cinacalcet

Sensitizes Ca2+-sensing receptor in parathyroid gland to circulating Ca2+, decreasing PTH
Used in refractory hypercalcemia in primary or secondary hyperparathyroidism

48

Sevelamer

Nonabsorbable phosphate binder that prevents phosphate absorption from the GI tract
Used in hyperphosphatemia in CKD